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Cervical cancer stages and its treatment options

04 Dec, 2023

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Cervical cancer is a serious medical condition that affects thousands of women worldwide. The prognosis and treatment options for cervical cancer depend largely on the stage at which it is diagnosed. Cervical cancer is typically divided into several stages, and each stage requires a different approach to treatment. In this blog, we will explore the various stages of cervical cancer and the corresponding treatment options for each stage.


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Stage 0 (Carcinoma in Situ):

In this earliest stage, also known as carcinoma in situ, abnormal cells are found on the surface layer of the cervix. These cells have not yet begun to invade deeper tissues but have the potential to develop into cancer. It's a pre-cancer stage, often detected during routine Pap smears, and is usually highly treatable.

Symptoms

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  • Abnormal vaginal bleeding: This can occur after sexual intercourse, between periods, or after menopause.
  • Unusual vaginal discharge: A change in the amount, color, smell, or consistency of discharge.
  • Mild pelvic discomfort: Rarely, there might be some discomfort in the pelvic area.
  • No symptoms: Often, Stage 0 cervical cancer presents no noticeable symptoms and is usually detected through routine Pap smears.

For Stage 0 cervical cancer, also known as Carcinoma in Situ, the treatment options are focused on removing or destroying precancerous cells, while aiming to preserve cervical function. These options include:

  • Cryosurgery: This involves freezing and destroying abnormal cells on the cervix. It's a minimally invasive procedure that targets only the affected cells.
  • Laser Therapy: In this method, a laser beam is used to burn off abnormal cells. It allows for precise treatment of affected areas without significant damage to surrounding healthy tissue.
  • Loop Electrosurgical Excision Procedure (LEEP): LEEP uses an electrical current passed through a looped wire to remove abnormal tissue. It's effective for excising precancerous cells and is widely used due to its precision.
  • Cone Biopsy (Conization): This involves removing a cone-shaped piece of cervical tissue. It's both diagnostic and therapeutic, allowing for the analysis of tissue and removal of affected areas.

Each of these treatments is carefully chosen based on the individual patient's condition and the extent of the precancerous changes. The goal is to treat effectively while maintaining the integrity and function of the cervix as much as possible.

Stage I (Early Stage Cervical Cancer):

Stage I cervical cancer marks the beginning of invasive cancer, where the cancer cells have moved beyond the surface layer of the cervix but are still confined to the cervix. This stage is divided into sub-stages IA and IB, which are differentiated based on the extent and depth of cancer invasion.

Stage IA (Microinvasive Cervical Cancer):

In Stage IA, the cancer is so small that it can only be detected under a microscope and has not yet spread into the deeper tissues of the cervix.

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Subcategories:

  • IA1: The cancerous lesion is less than 3 mm deep and 7 mm wide. It’s extremely localized and represents the very earliest form of invasive cervical cancer.
  • IA2: The cancerous area is more than 3 mm but not more than 5 mm deep and no more than 7 mm wide. While still microscopic, IA2 represents a slightly greater depth of invasion.

Typically, there are no specific symptoms associated with Stage IA cervical cancer. Most cases are detected during routine Pap smears or colposcopy examinations. The lack of symptoms underscores the importance of regular cervical cancer screening.

Stage IB (Clinically Visible Cervical Cancer):

Stage IB indicates a more significant presence of cancer. Unlike Stage IA, Stage IB cancer can usually be seen without the aid of a microscope, but it is still confined to the cervix.

Subcategories:

  • IB1: The cancerous lesion is less than 2 cm in size. It’s larger than in Stage IA but still relatively small.
  • IB2: The cancer is between 2 cm and 4 cm in size.
  • IB3: The lesion is larger than 4 cm in size, indicating a more substantial tumor within the cervix.

Detection and Symptoms: Women with Stage IB cervical cancer may start to experience symptoms, although they can still be minimal. Possible symptoms include abnormal vaginal bleeding (especially after intercourse, between periods, or post-menopause), unusual vaginal discharge, and potentially pelvic pain or pain during intercourse. However, it's not uncommon for Stage IB cervical cancer to be asymptomatic, which again highlights the importance of regular screening.

Treatment for Stage IA

This stage involves small, early-stage tumors confined to the cervix.

  • Cone Biopsy: For very small tumors, a cone biopsy, which removes a cone-shaped piece of cervical tissue, may be sufficient.
  • Simple Hysterectomy: This procedure involves the removal of the uterus and may preserve the ovaries, especially in younger women, to maintain hormonal balance.
  • Fertility-Sparing Options: For women who wish to preserve fertility, a radical trachelectomy can be considered. This surgery involves the removal of the cervix and the upper part of the vagina, but it leaves the uterus in place, allowing the possibility of future pregnancy.

Treatment for Stage IB

In this stage, the cancer is larger but still confined to the cervix.

  • Radical Hysterectomy: This surgery involves the removal of the uterus, a portion of the vagina, and nearby lymph nodes. It's a more extensive procedure compared to a simple hysterectomy.
  • Radiation Therapy: This may be used, sometimes in combination with chemotherapy, especially if surgery isn't an option or if there are concerns about cancer cells remaining post-surgery.
  • Chemotherapy: Often used in combination with radiation therapy. The chemotherapy helps to enhance the effectiveness of radiation and can also help in managing cancer that has spread too small to be seen.

The choice of treatment in Stage I cervical cancer depends on various factors, including the size of the tumor, the patient's overall health, and their fertility desires. The goal of treatment at this stage is typically to cure the cancer while preserving as much normal function as possible. Regular follow-up is crucial to monitor for any recurrence of the disease.


Stage II:

Stage II cervical cancer indicates that the disease has spread beyond the cervix to nearby areas but has not yet reached the walls of the pelvis or the lower third of the vagina. This stage is divided into sub-stages IIA and IIB, which are based on how far the cancer has spread within the pelvic region.

Stage IIA (Limited Spread Beyond the Cervix):

In Stage IIA, the cancer has extended beyond the cervix to the upper two-thirds of the vagina, but it has not spread to the parametrial area (the tissues surrounding the cervix).

Subcategories:

  • IIA1: The cancer is not larger than 4 cm.
  • IIA2: The cancer is larger than 4 cm.

Symptoms may become more noticeable in this stage. These can include abnormal vaginal bleeding (including postcoital bleeding), unusual vaginal discharge, and possibly pelvic pain. The increase in the size of the tumor may lead to more noticeable symptoms compared to earlier stages.

Stage IIB (Involvement of Parametrial Tissue):

In Stage IIB, the cancer has spread to the parametrial tissues but not to the pelvic wall.

  • The symptoms in Stage IIB are similar to those in Stage IIA, potentially with an increase in severity. There may be more pronounced pelvic pain, back pain, problems with urination, and even swelling of a leg if the cancer blocks lymphatic drainage.
  • The spread to the parametrial tissue represents a more advanced local spread of the cancer, which may necessitate more aggressive treatment approaches.


Treatment of Stage II cervical cancer

In the treatment of Stage II cervical cancer, the approach is more aggressive due to the cancer's spread beyond the cervix but not yet to the walls of the pelvis or lower part of the vagina. The treatment options for this stage are:

  • Radiation Therapy and Chemotherapy: This combination is often the primary treatment, especially for stage IIB cervical cancer. Radiation therapy involves using high-energy rays to destroy cancer cells, while chemotherapy, typically platinum-based like cisplatin, helps to kill cancer cells and enhance the effectiveness of radiation. This combination is effective in controlling the cancer's spread and killing any microscopic cancer cells that might remain.
  • Radical Hysterectomy and Removal of Lymph Nodes: For stage IIA cervical cancer, where the cancer has spread to the upper two-thirds of the vagina but not to the pelvic wall or lower third of the vagina, a radical hysterectomy may be considered. This surgery involves removing the uterus, cervix, part of the vagina, and nearby lymph nodes. Post-surgery, radiation or chemoradiation might be recommended to ensure any remaining cancer cells are destroyed, especially if there are high-risk features found in the surgical specimen.



Stage III:

Stage III cervical cancer signifies a more advanced disease where the cancer has spread beyond the cervix and uterus, reaching other areas within the pelvic region. This stage is divided into sub-stages IIIA and IIIB, based on the extent of the spread.


Stage IIIA (Spread to the Lower Vagina):

In Stage IIIA, the cancer has spread to the lower third of the vagina but not to the pelvic wall.

Detection and Symptoms: Symptoms may include noticeable changes in vaginal bleeding patterns, including bleeding after intercourse, between periods, or post-menopause. There may also be an increase in vaginal discharge. Pelvic pain, back pain, and discomfort during sexual intercourse can also occur.

Even though the cancer has spread to the lower vagina, it has not yet reached the pelvic wall, which is a significant boundary for the spread of cervical cancer.

Stage IIIB (Involvement of Pelvic Wall and/or Hydronephrosis):

Stage IIIB indicates a further spread of cancer. It has either reached the pelvic wall or is causing hydronephrosis (swelling of a kidney due to a backup of urine) or non-functioning of a kidney because it has blocked the ureters (the tubes that carry urine from the kidneys to the bladder).

Detection and Symptoms: In addition to the symptoms seen in Stage IIIA, Stage IIIB can present with more severe symptoms such as pain or problems with kidney function. Swelling in one of the legs, pain or difficulty when urinating, and back pain due to the effect on the ureters or kidneys are also possible.

The involvement of the pelvic wall or kidneys signifies a more extensive spread and may complicate treatment.

Treatment for Stage III cervical cancer

  • Stage III cervical cancer: Cancer has spread to the lower part of the vagina or the walls of the pelvis and may be blocking the ureters.
  • Primary treatment approach: A combination of radiation therapy and chemotherapy is the central approach for Stage III cervical cancer.
  • Radiation Therapy: Uses high-energy rays to destroy cancer cells and shrink tumors. It's a localized treatment that targets the affected areas.
  • Chemotherapy: Works to kill cancer cells throughout the body. It complements radiation therapy by enhancing its effectiveness and addressing cancer cells that may have spread.
  • Treatment goal: The main objective of this dual approach is to control the cancer as much as possible and provide relief from symptoms associated with the cancer.
  • Surgery not usually an option: At this stage, the cancer has spread to an extent where surgery is generally not a viable option due to the cancer's location and spread.
  • Focus on difficult-to-operate areas: Instead of surgery, the emphasis is on treatments that can effectively reach cancer cells throughout the body and address areas that are challenging to operate on.
  • Intensive treatment: Treatment for Stage III cervical cancer is intensive and requires careful monitoring for both its effectiveness and potential side effects.


Stage IV (Advanced Cervical Cancer):

Stage IV cervical cancer is the most advanced stage of the disease, indicating that the cancer has spread beyond the pelvis or has invaded nearby organs. This stage is divided into sub-stages IVA and IVB, reflecting the extent of the spread.


Stage IVA (Spread to Adjacent Organs):

In Stage IVA, the cancer has spread to nearby organs, such as the bladder or rectum, but it has not yet spread to distant parts of the body.

Detection and Symptoms: Symptoms in this stage are more severe due to the involvement of adjacent organs. These can include pain during urination, blood in the urine (indicating bladder involvement), or changes in bowel habits and blood in the stool (indicating rectal involvement). Pelvic pain, heavy vaginal bleeding, and severe back pain can also be present.

Additional Considerations: The involvement of the bladder or rectum represents a significant spread of the disease and complicates treatment.

Stage IVB (Distant Metastasis):

This is the most advanced substage, where the cancer has spread to distant organs such as the lungs, liver, bones, or other regions far from the cervix.

Detection and Symptoms: Along with the symptoms seen in Stage IVA, Stage IVB can present with symptoms related to the specific organs affected by the metastases. This might include coughing or shortness of breath (if the lungs are involved), pain in the affected bones, or general symptoms such as fatigue, weight loss, and a decrease in overall health.

Additional Considerations: The presence of distant metastasis signifies a critical spread of the disease and usually indicates a need for systemic treatment approaches.

In Stage IV cervical cancer, the most advanced stage, the cancer has spread beyond the pelvis or is affecting other organs.


Treatment for Stage IVA

In this stage, cancer has spread to nearby organs like the bladder or rectum but has not yet spread to distant parts of the body.

  • Radiation Therapy and Chemotherapy: This combination is the mainstay of treatment in Stage IVA. Radiation therapy is used to target and destroy cancer cells in specific areas, while chemotherapy works systemically to kill cancer cells throughout the body. This approach aims to control the spread of the cancer and alleviate symptoms caused by the tumor.

Treatment for Stage IVB

At this stage, the cancer has spread to distant organs, such as the lungs or liver.

  • Palliative Care: The focus shifts to relieving symptoms and improving the quality of life for patients. Palliative care includes managing pain, nutritional support, and addressing psychological and social needs. It is a crucial component of treatment at this advanced stage.
  • Targeted Therapy: Medications like bevacizumab target specific aspects of cancer cells. These therapies work by interfering with the cancer cells' ability to grow and spread.
  • Immunotherapy: Treatments such as pembrolizumab can be effective, especially in cancers with specific genetic characteristics. Immunotherapy works by helping the immune system recognize and attack cancer cells.
  • Clinical Trials: Participation in clinical trials for new treatments may be considered. These trials provide access to the latest treatment options and contribute to the ongoing research in cervical cancer treatment.

The treatment for Stage IV cervical cancer is highly individualized, focusing on managing the disease, prolonging survival, and maintaining the best possible quality of life. The choice of treatment depends on various factors, including the location of the metastasis, the patient’s overall health, and their treatment preferences. Regular monitoring and adjustments to the treatment plan are essential to manage this advanced stage of cancer.


Cervical cancer is a complex disease with various stages, each requiring a tailored approach to treatment. Early detection through regular screenings like Pap smears is crucial, as it allows for intervention in the earliest stages when the cancer is most treatable. Treatments range from removing precancerous cells in Stage 0 to more aggressive approaches like radiation and chemotherapy in advanced stages. Regular follow-ups and monitoring are critical at every stage to assess treatment effectiveness. With early detection and appropriate care, the prognosis for many patients can be positive, emphasizing the importance of staying informed and seeking regular screenings.

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FAQs

Cervical cancer has stages ranging from 0 to IV, with each stage indicating the extent of the disease. Treatment options vary based on the stage. Early stages (0 and I) typically involve less invasive treatments, while advanced stages (II to IV) may require more aggressive approaches like radiation and chemotherapy.